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OHSU Physician-Researchers Help Develop New Guidelines for Evaluating Children with Cerebral Palsy

03/26/04 Portland, Ore.

Evidence-based guidelines published as special article in the journal Neurology

Children with cerebral palsy shouldn't need a battery of tests to evaluate the cause of the disorder or how to treat it, according to scientifically based guidelines developed by the American Academy of Neurology and the Child Neurology Society. Instead, the organizations recommend magnetic resonance imaging (MRI) following diagnosis based on the medical history and physical examination, as well as early screening for other physical disorders that may be related to cerebral palsy. The guidelines were published in the March 23 issue of Neurology, the scientific journal of the American Academy of Neurology.

"We have been ordering too many costly tests for this common disorder, which creates undue anxiety for the child and parent," said Barry Russman, M.D., pediatric neurologist at Oregon Health & Science University Doernbecher Children's Hospital and director of pediatric neurology at Shriners Hospitals for Children-Portland. Russman led the research committee and was a co-author of the guidelines. "Now the standard of care for evaluating the cause of this disorder in these children is driven by evidence that shows these additional tests should be done only on a case-by-case basis."

The research team reviewed more than 350 scientific articles and abstracts during a 2 1/2 year period to determine the most effective methods for evaluating children after a diagnosis of cerebral palsy.

There are many causes for cerebral palsy, such as genetic disease, brain malformation, infection or injury in the developing brain that affects posture and movement. The evidence showed that MRIs should become the routine evaluation tool for determining the cause of cerebral palsy, which is not the case currently. MRI is preferred over computerized tomography. However, additional metabolic and genetic studies are not needed unless the cause of the brain's abnormality isn't evident from the MRI or from clinical history and examination.

The sooner a child is properly diagnosed with cerebral palsy the better his or her caregivers and physicians can work together in better understanding the cause of the disorder and creating an effective treatment plan.

Cerebral palsy may be the tip of the iceberg for these children, said Russman, who is also an adjunct professor of pediatrics and neurology in the OHSU School of Medicine. They are likely to have related disorders such as mental retardation; epilepsy; hearing deficits; speech and language disorders; problems with vision; and swallowing disorders, so they should be screened for these as well, according to the guidelines.

Cerebral palsy is a common problem, occurring in about two births per 1,000 worldwide. In the United States, about 10,000 babies are born each year with cerebral palsy, according to the American Academy of Neurology.

Russman said the data gathered during this study have changed the way he will care for children. "I'm convinced that every child with cerebral palsy should have an MRI. It will provide insight as to why the child has the problem. Further, it can help decide whether more testing is necessary."

"I think these guidelines will be hugely beneficial for physicians who don't care for children with cerebral palsy routinely because it provides them with parameters for evaluating these children more effectively and efficiently," said Peter Blasco, M.D., co-author of the guidelines; associate professor of pediatrics in the OHSU School of Medicine; director of the Neurodevelopmental Program at the OHSU Child Development and Rehabilitation Center; and neurodevelopmental pediatrician at Shriners Hospitals for Children-Portland

OHSU Doernbecher Children's Hospital provides the region's widest range of children's health care services and is the primary center for Oregon Health & Science University's pediatric programs. Doernbecher is nationally recognized for its neurology, cardiology and oncology programs. More than 200 pediatric specialists at Doernbecher care for 40,000 children each year from Oregon and surrounding states.